Test Center Number Test Center Name 1St Test Date / s1

The New York State Education Department TASC™ High School Equivalency Office 89 Washington Avenue, Room 460 EBA ATTENDANCE Albany, NY 12234 SHEET (2016) Test Center Name 3-Digit Test Center # 1st Date of Testing Test Center Address TASC™ Coordinator or Examiner – Type Name English Spanish Total Number of Examinees TASC™ Coordinator or Examiner – Signature (In Blue Ink) Tested Coordinator or Examiner ( ) - Phone Coordinator or Examiner E- Test Mode CBT PBT Mail

Eligibility Codes (EC) for 16, 17 and 18 year olds Age on 1st Day Required Proof of (EC codes do not apply to anyone 19+ years old) of Test Eligibility EC Definition of EC Code 16 (Keep at Test Center) 0 Examinee is foreign born and never attended K-12 schools in the United States. F 1 Examinee has been out of high school for a year. B 2 Examinee was a member of a high school class that has graduated. B 3 The examinee is enrolled in an Alternative High School Equivalency (ASHEP) Program. X T-TAF (Note: The second digit of the ASHEP Preparation Code must be a four (4) or higher). (send copy to NYSED) 4 The examinee has been accepted into the United States Armed Forces. X D 5 The examinee has been accepted into a college or post-secondary institution. X D 6 The examinee is enrolled in a Job Corps program. D 7 The examinee is incarcerated or institutionalized. E 8 The examinee is an adjudicated youth or is under the direction of a prison, jail, detention center, court, parole or probation office. E 9 The examinee has been home schooled. X B List of examinees taking the TASC™ test during this test session (2016). Alphabetize this list by last name of the examinee. Test Form(s) Age 16, 17 9 Digit DOB Taken by Appendix or18 EC 5-Digit # Last Name First TASC ID (mm/dd/yyy Examinee H? Code Prep Code T-TAF Name (UUID) y) (D, E or F)

Social Writing Studies Science Reading Math 1 2 3 4 5 6 7 8 9 10 Coordinators or Examiners must send the following materials to NYSED within five (5) days of the last day of testing: Attendance Sheet, Signature Cards, T-TAF (if applicable), Accommodations Approval Letter (if applicable), Accommodations Waiver Form (if applicable), and Appendix H-Incident/Irregularity Report (if applicable). Test Center Number Test Center Name 1st Test Date / /

List of examinees taking the TASC™ test during this test session (2016). Alphabetize this list by last name of the examinee. Test Form(s) Taken by Examinee (D, E or F) Age 16, 17 9 DOB Social Appendix or 18 EC 5-Digit # Last Name First Name (mm/dd/yyy Writing Studies Science Reading Math H? Code Prep Code T-TAF D y) i g i t

T A S C

I D ( U U I D ) 11

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26. 27 28 29 30 31 32 33 34 35 Coordinators or Examiners must send the following materials to NYSED within five (5) days of the last day of testing: Attendance Sheet, Signature Cards, T-TAF (if applicable), Accommodations Approval Letter (if applicable), Accommodations Waiver Form (if applicable), and Appendix H-Incident/Irregularity Report (if applicable).

Test Center Number Test Center Name 1st Test Date / /

T A S C

I D ( U U I D ) 36

37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Coordinators or Examiners must send the following materials to NYSED within five (5) days of the last day of testing: Attendance Sheet, Signature Cards, T-TAF (if applicable), Accommodations Approval Letter (if applicable), Accommodations Waiver Form (if applicable), and Appendix H-Incident/Irregularity Report (if applicable).

List of examinees taking the TASC™ test during this test session (2016). Alphabetize this list by last name of the examinee. Test Form(s) Taken by Examinee (D, E or F) Age 16, 17 9 DOB Social Appendix or 18 EC 5-Digit # Last Name First Name (mm/dd/yyy Writing Studies Science Reading Math H? Code Prep Code T-TAF y) D i g i t

T A S C

I D ( U U I D ) 61

62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 Coordinators or Examiners must send the following materials to NYSED within five (5) days of the last day of testing: Attendance Sheet, Signature Cards, T-TAF (if applicable), Accommodations Approval Letter (if applicable), Accommodations Waiver Form (if applicable), and Appendix H-Incident/Irregularity Report (if applicable).

T A S C

I D ( U U I D ) 86

87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102. 103. 104 105 106 107 108 109 110 Coordinators or Examiners must send the following materials to NYSED within five (5) days of the last day of testing: Attendance Sheet, Signature Cards, T-TAF (if applicable), Accommodations Approval Letter (if applicable), Accommodations Waiver Form (if applicable), and Appendix H-Incident/Irregularity Report (if applicable).

T A S C

I D ( U U I D ) 111

112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 Coordinators or Examiners must send the following materials to NYSED within five (5) days of the last day of testing: Attendance Sheet, Signature Cards, T-TAF (if applicable), Accommodations Approval Letter (if applicable), Accommodations Waiver Form (if applicable), and Appendix H-Incident/Irregularity Report (if applicable). Page 6 (01/06/2016)